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AND
RUMBLE
VENTURES,
INC.
TUBERCULOSI
S
(TB)
POLICY
PROGRAM
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What is Tuberculosis?
Tuberculosis (TB) has been a public health concern wherein millions have died
from it worldwide (with more mortality compared to SARS and the Avian Flu). But
even with the nationwide campaign against TB for decades now, it has remain
among the top 10 morbidity and mortality of Filipinos -with 75 Filipinos dying from
it everyday as based in the 2003 data from the Philippine Tuberculosis Initiatives
for the Private Sector (PhilTIPS).
On 2004, the DOH together with the support of DOLE and other government
agencies launched the Comprehensive and Unified Policy ( C.U.P. 2004) for
Tuberculosis Control in the Philippines. And on October 2005, the Department of
Labor and Employment (DOLE) Secretary Patricia Sto. Tomas issued Department
Order No. 73-05, Series of 2005 or the Guidelines for the implementation of Policy
and Program on Tuberculosis prevention and control in the workplace. The DOH
has been advocating the PPM-TB (Private Public Mix), private practitioners may
refer their patients to TB DOTS facilities for free treatment using a two-way
referral system. The referring MD has no worry to loss their patient, since the TB
DOTS facilities ask the referred patient to return for ff-up with their attending MD.
Please do not hesitate to refer TB patients to the TB DOTS treatment centers, TB
DOTS is an effective public health program against tuberculosis.
What is TB-DOTS?
Directly Observed Treatment Short Course or DOTS is a comprehensive strategy to
control TB.
Key difference of DOTS from Non-DOTS Treatment:
Emerging threats like Multidrug resistant TB (MDR-TB) and the Extremely Resistant
variety (XDR-TB) is on the rise partly due to poor compliance and poor patient
follow-up especially those who are treated outside the TB DOTS Program. Most of
the Company Physicians either will start the patient on anti-Kochs with no regular
follow up and no assurance to treatment compliance (of the patient) or refer the
patient to a Pulmonologist rather than referring the employee to a TB DOTS
treatment Facility. TB Drugs are very costly but these drugs are available for free
in the TB DOTS Centers and follows the Direct Observed Treatment Strategies thus
improving the chances of being cured.
Drug-resistant TB
Within a large population of any living organisms, there will be some individuals
that due to a mutation have a different feature which might (or might not)
possibly give its owner an advantage under certain circumstances.
The same is true of bacteria, although they reproduce asexually. They exist in very
large numbers and individual mutant bacteria will exist with features such as a
different cell wall structure or a different metabolism (way of working at a
chemical level), either due to a modified version of a gene, or an extra gene.
When these are challenged by being exposed to antibiotic taken by the patient
they survive and reproduce, passing on the gene responsible to their offspring - a
clone of themselves. As a result the other (antibiotic-sensitive) bacteria die and
are replaced by the offspring of the mutant form which make an antibioticresistant strain.
This situation has unfortunately developed with TB on a worldwide scale. Strains
which are resistant to one antibiotic can also develop resistance to other
antibiotics. Multiple drug resistant - MDR - strains are produced as a result,
and these are very difficult, if not impossible, to treat with antibiotics. There are
several categories of antibiotics, depending on their agreed role in treatment: first
line, second line, third line. Isoniazid and rifampicin are first line drugs.
Extensively (or extremely) drug-resistant tuberculosis (XDR-TB) is not treatable
using first and second line drugs.
The phenomenon of extensively drug resistant strains has a number of ethical
consequences. In some instances, many of which have attracted media attention,
sufferers have been forcibly excluded from exposure to the general public;
compulsory quarantine is not far removed from imprisonment!
TB treatment regimes
The treatment of TB is essentially quite different from that of other diseases:
it takes a long time, and must not be stopped if the sufferer feels some
improvement
it uses drugs (antibiotics etc) that are not cheap, especially in relation to
income in developing countries
This depends on the sufferer being expected to be seen to take their medication
under the supervision of another qualified individual, who can check the drug
requirements and carry out the appropriate administration, as well as the
necessary backup arrangements. The main points of this programme are as
follows: